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2011-025
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2011-025
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Last modified
1/12/2016 1:40:33 PM
Creation date
10/1/2015 1:39:12 AM
Metadata
Fields
Template:
Official Documents
Official Document Type
Contract
Approved Date
02/08/2011
Control Number
2011-025
Agenda Item Number
8.D.
Entity Name
Timothy Rose Contracting
Subject
Indian River Boulevard Sidewalk Improvements
Area
12th Street to 17th Street
Project Number
0745
Bid Number
2011023
Archived Roll/Disk#
112-0006-R
Supplemental fields
SmeadsoftID
9258
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CERTIFICATE OF LIABILITY INSURANCE 2/11/2011 <br /> Producer: Lion Insurance Company This Certificate Is Issued as a matter of information only and confers no rights <br /> 2739 U . S . Highway 19 N . upon the Certificate Holder. This Certificate does not amend, extend or alter <br /> Holiday , FL 34691 the coverage afforded by the policies below. <br /> (727 ) 938 -5562 Insurers Affording Coverage NAIC # <br /> Insured : South East Personnel Leasing , Inc . Insurer A: Lion Insurance Company 11075 <br /> 2739 U . S . Highway 19 N . Insurer B : <br /> Holiday , FL 34691 Insurer C : <br /> Insurer D : <br /> Insurer E : <br /> Coverages <br /> e poicies o insurance listed below have been issued to the insurename a ove for the policy period indicated . Notwithstanding arty requirement, term or con <br /> mon of arry contractor other document with respect to is <br /> ns certificate maybe issued or may pertain , the insurance afforded by the policies described herein is subject to all the terms , exclusions, and conditions <br />of such policies . Aggregate limits shown may have been reduced by <br /> paid claims. <br /> Ill ADDL Policy Effective Policy Expiration Date <br /> LTR INSRD Type of Insurance Policy Number Date Limits <br /> ( MM/DD/YY) ( MM/ )D/YY) <br /> GENERAL LIABILITY <br /> Each Occurrence $ <br /> Commercial General Liability <br /> Damage to rented premises (EA <br /> Claims Made Occur occurrence) <br /> Med Exp <br /> PUeneral aggregate limit applies per : Personal Adv InjuryPolicy Project LOC General <br />AggregateProducts - Corl Agg <br /> TOMOBILE LIABILITY Combined Single Limit <br /> Any Auto (EA Accident) <br /> All Owned Autos Bodily Injury <br /> Scheduled Autos (Per Person) <br /> Hired Autos Bodily Injury <br /> Non. Owned Autos (Per Accident) <br /> Property Damage <br /> (Per Accident) <br /> EXCESSIUMBRELLA LIABILITY Each occurrence <br /> Occur ® Claims Made Aggregate <br /> Deductible <br /> A Workers Compensation and WC 71949 01 /01 /2011 01 /01 /2012 X1 WC statu- oTH- <br /> Employers' Liablily tory Limits ER <br /> Any proprietorlpartner/executive officer/member E.L . Each Accident $ 1 .000 ,000 <br /> excluded? <br /> If Yes, describe under special provisions below. E.L . Disease - Ea Employee $ 1 .000 ,000 <br /> E.L . Disease - Policy Limits $ 1 ,000 .000 <br /> Mer Lion Insurance Company is A. M . Best Company rated A- ( Excellent) . AMB # 12616 <br /> Descriptions of Operations/Locations/Vehicles/Exclusions added by Endorsement/Special Provisions : Client ID : 31-65-108 <br /> Coverage only applies to active employee(s) of South East Personnel Leasing, Inc . that are leased to the following "Client Company" : <br /> Timothy Rose Contracting, Inc . <br /> Coverage only applies to injuries incurred by South East Personnel Leasing, Inc . active employee(s) while working in Florida . <br /> Coverage does not apply to statutory employee(s) or independent contractor(s) of the Client Company or any other entity. <br /> A list of the active employee(s) leased to the Client Company can be obtained by faxing a request to (727) 937-2138 or by calling (727) <br /> 938-5562 . <br /> Project Name : INDIAN RIVER SIDEWALK IMPROVEMENTS, INDIAN RIVER COUNTY, FL <br /> FAX: 772- 564-7888 & 772-770-5140 / ISSUE 02- 11 - 11 (TD) <br /> in Date : 2 4 <br /> CERTIFICATE HOLDER CANCELLATION2009 <br /> INDIAN RIVER COUNTY BOARD OF COUNTY Should any of the above described policies be cancelled before the expiration data thereof, the issuing insurer <br /> will <br /> endeavor to mail 30 days written notice to the certificate holder named to the left, but failure to do so shall impose no <br /> COMMISSIONERS, PURCHASING DIVISON <br /> obligation or liability of ary Idnd upon the insurer, its agents or representatives . <br /> 1800 27TH STREET <br /> VERO BEACH, FL 32960 nor <br />
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